The "R" in SBAR......nope

Nursing Students Student Assist

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I'm really not understanding the recommendation part of SBAR. I understand what it is that I'm supposed to do (tell the attending provider what my recommendations are), but I have no idea how to go about doing this. I think it's because I'm a nursing student. Not a medical student. (Sarcasm, sorry, I'm frustrated). How am I supposed to know every single diagnostic test? Somebody please shed some light on this. I am starting to think I'm just not smart enough to be a nurse.

OP... 1st year student here too. I look at it this way, would you rather have this "map" as a way to organize your thoughts and information or be all over the place when calling a doc? It's the SBA that's important right now... We'll eventually figure out the R...?

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OP... 1st year student here too. I look at it this way, would you rather have this "map" as a way to organize your thoughts and information or be all over the place when calling a doc? It's the SBA that's important right now... We'll eventually figure out the R...?

I freaking love ... love your little icon pic.

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OP, that attitude is what will continue to oppress the nursing profession.

The fact is YOU'RE the one with the patient. Not the doctor. YOU have the best view and you know the patient best. As an RN you continually assess without even thinking about it. So you end up knowing a patient pretty well, this is why YOUR input is often appreciated. You are not telling an MD how to do their job, you're working WITH the MD to get the job done and have a patient's health and comfort restored/maximized.

What attitude? The sarcasm part? If that were true, god help the nursing profession because nursing students will get frustrated and feel lost. If you're referring to something else that I said, maybe you should reread my original post and realize that I'm a student. Not a nurse, yet. And just because you may be a nurse, doesn't mean you know what will and will not "continue" to oppress the nursing profession. I doubt that students who get frustrated with hard concepts that they are still learning, and expressing these feelings in a place where it's supposed to be safe to do so, will oppress the nursing profession. It's not like I'm going into work every day saying how xyz doesn't make sense and is insane, again, because I'm not a nurse yet. If you think a first year nursing student's attitude is a predictor for what their attitude will be like for the rest of their career, or that a first year student's attitude has the power to oppress a whole profession, you should probably consider taking yourself less seriously. Or, you can continue to give credence to the whole "they eat their young". I get that the nursing field does not need to be degraded more than it sometimes is. I'm not contributing to that.

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OP... 1st year student here too. I look at it this way, would you rather have this "map" as a way to organize your thoughts and information or be all over the place when calling a doc? It's the SBA that's important right now... We'll eventually figure out the R...

I hear ya :) It definitely is easier to focus on the SBA for now, in order to get more comfortable with the R, eventually!

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Ha ha yeah especially if they fall back to sleep when on the phone with you!!

LOL Oh dear..........! Has this actually happened?!

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Specializes in Emergency Room, Trauma ICU.
LOL Oh dear..........! Has this actually happened?!

No thankfully. I'm in the ER so my docs are right there in person. Just a story I heard as a new grad in the trauma ICU.

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What attitude? The sarcasm part? If that were true, god help the nursing profession because nursing students will get frustrated and feel lost. If you're referring to something else that I said, maybe you should reread my original post and realize that I'm a student. Not a nurse, yet. And just because you may be a nurse, doesn't mean you know what will and will not "continue" to oppress the nursing profession. I doubt that students who get frustrated with hard concepts that they are still learning, and expressing these feelings in a place where it's supposed to be safe to do so, will oppress the nursing profession. It's not like I'm going into work every day saying how xyz doesn't make sense and is insane, again, because I'm not a nurse yet. If you think a first year nursing student's attitude is a predictor for what their attitude will be like for the rest of their career, or that a first year student's attitude has the power to oppress a whole profession, you should probably consider taking yourself less seriously. Or, you can continue to give credence to the whole "they eat their young". I get that the nursing field does not need to be degraded more than it sometimes is. I'm not contributing to that.

OP, not attitude in the direct definition of the word. Attitude as in your perception of making suggestions to the doctor. It almost seems as if you were surprised that this happened. You expressed opposition to the R in SBAR... that attitude OP.

I'm not eating young ... LOL

If you think I'M eating young, then you have nooooooo idea what young eating is. I merely made a suggestion.

And ... sorry to break it to you but as a student nurse you begin to represent the nursing profession.

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Specializes in Emergency Department.

OP: You use the SBA part to paint a picture of the patient for the Doc. Effectively you're telling the Doc what's wrong. The "R" represents your suggestion as to what you think the patient needs to address the problem you just described.

Simply put, if you've got a patient that's vomiting a lot, what does your patient need? 1) to stop vomiting. How? Antiemetic. Ask for it. 2) Fluid replacement. PO isn't going to do it until the antiemetics kick in... so, IV bolus? Ask for it. 3) protracted vomiting can cause metabolic problems... how do you find out if something's brewing? Get some labs. Ask for it...

If you don't ask, the doc is going to have to guess at why you're calling and may end up writing orders that don't actually address the problem.

Your vomiting patient might need the above stuff... but because you didn't ask, the Doc guessed and ordered Zofran and potassium... PO. That's not exactly meeting the needs... because the patient needs IV Zofran, fluid replacement... and maybe K down the road.

Do you see where I'm going with this?

Think of the "R" as a way of saying "Hey Doc, I need an order for..." and your SBA told the Doc why you need that order.

Personally, I'm used to doing SBAR in a slightly different order: RASB. That way is essentially what I want, why I want it, and the evidence/info that led me there.

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Specializes in SICU, trauma, neuro.

Hugs...and deep breath. Of course you're a 1st year nursing student and are not expected to know the correct medical intervention every time. Keep in mind though, that there may come a day that you're the crusty old bat RN and working with a first-year resident. :yes:

True story here--one night a colleague told the neurosurg resident that her pt's ICP was in the 40s. (If you haven't studied that yet, that is intracranial pressure; we get very concerned if it's >20 for five minutes.) The resident was brand new to the service and a 2nd year, and her response was: "Okay. (pause). What should we do??"

Remember that you may have 4-7 pts if you work med-surg, 1-2 if you work ICU. The MD might be the provider for dozens of pts in the hospital at any given time. And then if it's in the middle of the night, they might be woken from the very little sleep they've gotten in days. If you work LTC, that on-call provider may not know that resident from Adam.

Also remember that the MD/NP will not withhold orders if you don't give the perfect SBAR. You might be at a complete loss of what to recommend; there are situations where very experienced RNs can throw out suggestions but might not be 100% confident on the right decision either. But that provider is not going to tell you, "Can't help you. You didn't spell out exactly what the pt needs in that SBAR." They might ask you a bunch of questions to arrive at the best course of action in that case.

How I do it, is if I know what I want I'm upfront. It's a waste of my time and theirs to play clueless. If I'm not sure, I'll give them all the info that I think is pertient and then ask, "What are your thoughts?" Sometimes I'm wrong. I'll tell you another story, the other day I was POSITIVE my pt had developed a pneumonia. He'd fallen from a ladder the day before and had lost consciousness and vomited at the scene. His breathing was becoming labored, his SpO2 was down to 92% on 4L, his lung sounds were coorifice, and this WBC count went from approx. 10 to 26 that a.m. When calling the dr., I gave her the info and just said "He didn't have a CXR this a.m.; do you want me to order one now?" We got the CXR, and it turned out he just had some pulmonary edema, and 10 mg IV Lasix fixed him. (and I was definitely happy to have been wrong! hehe)

Do you want to be an RN who can collaborate with the provider, or who is blindly dependent on others to tell her what to do?

It DOES get easier with time and experience, I promise!

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OP, not attitude in the direct definition of the word. Attitude as in your perception of making suggestions to the doctor. It almost seems as if you were surprised that this happened. You expressed opposition to the R in SBAR... that attitude OP.

I'm not eating young ... LOL

If you think I'M eating young, then you have nooooooo idea what young eating is. I merely made a suggestion.

And ... sorry to break it to you but as a student nurse you begin to represent the nursing profession.

Sorry to break it to you......but expressing opposition to something, albeit temporarily, because I'm frustrated, and can't wrap my head around it, does not make me an oppressor of the whole nursing profession. Can you imagine if nurses never questioned things? If we only did what has always been done instead of using EBP? Many students, and nurses, express opposition to concepts, and some never make room for other points of view. Also, as a student nurse, I begin to represent the nursing profession? Why? Because you say so? You don't get to have a monopoly over any unspoken laws of the nursing world just because you're a nurse instead of a student. And even if you did, so what? I don't find anything wrong with the way I have represented the profession, thus far. I have absolutely no problem questioning things, especially when said things don't make sense to me. If there is this given rule that every single nursing student represents the profession as soon as they begin learning, than I'm proud to do so by questioning things instead of blindly following what my professors say. If I didn't care about being the best nurse I can be, I wouldn't have been so upset at feeling lost. If I didn't care about learning everything I can to be a great nurse, I wouldn't have posed the question in the first place. You really come across as a know-it-all by saying things like "this attitude will do this to the profession" and "you have nooooooo idea what eating young is". I've seen nurses eat their young. I used the phrase in my response to you to make a point. I'm a student, but I'm not that naive. You did not merely make a suggestion. You presented your opinion as fact.

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Do you want to be an RN who can collaborate with the provider, or who is blindly dependent on others to tell her what to do?

Here. I. Stand. Thank you for your input and for giving me some great examples from your practice for me to chew on. I definitely don't want to be blindly dependent on others to tell me what to do, thank you for putting that in perspective for me! I really want to get better at SBAR, and do everything I can to be as clear and concise as possible for my future patients. It seems like S+B = A, and the R is dependent on the A. Am I on the right track?

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"Simply put, if you've got a patient that's vomiting a lot, what does your patient need? 1) to stop vomiting. How? Antiemetic. Ask for it. 2) Fluid replacement. PO isn't going to do it until the antiemetics kick in... so, IV bolus? Ask for it. 3) protracted vomiting can cause metabolic problems... how do you find out if something's brewing? Get some labs. Ask for it..."

Thank you SO much! This is really helpful. I'm copying this part to my notes so that I can have a clear summary of SBAR if I get lost again!

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